Chapter 17 Endocrine and Hematologic Emergencies Endocrine System A complex message and control system. Glands secrete. Hormones are chemical

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1 Chapter 17 Endocrine and Hematologic Emergencies Endocrine System A complex message and control system. Glands secrete. Hormones are chemical messengers. System maintains Diabetes (1 of 2) Diabetes affects the body s ability to use (sugar) for fuel. Occurs in about 7% of the population Complications include blindness, cardiovascular disease, and failure. Diabetes (2 of 2) As an EMT, you need to know signs and symptoms of blood glucose that is: High ( ) Low ( ) Central problem in diabetes is lack, or ineffective action, of insulin. Defining Diabetes (1 of 2) Diabetes mellitus Metabolic disorder in which the body cannot glucose Usually due to a lack of. Glucose One of the basic sugars in the body 1

2 One of the basic sugars in the body Along with oxygen, it is a primary fuel for metabolism Defining Diabetes (2 of 2) Insulin Hormone produced by the Enables glucose to enter the cells Without insulin, cells starve Hormone Chemical substance produced by a Has special regulatory effects on other body organs and tissues Type I Diabetes Insulin-dependent diabetes (IDDM) Patient does not produce any Insulin injected daily Onset usually in Type II Diabetes Non-insulin-dependent diabetes (NIDDM) Patient produces amounts of insulin Usually appears later in life Disease may be controlled by or oral hypoglycemics Severity of Diabetes Severity of diabetic complications depends on patient s average blood glucose level and when 2

3 patient s average blood glucose level and when diabetes began. increases the risk of diabetes. Diabetes every other medical condition and injuries Role of Glucose and Insulin Glucose is the major source of for the body. Constant supply of glucose needed for the brain. Insulin acts as the for glucose to enter cells. Normal glucose (blood sugar) is to mg/dl. Insulin Classic Symptoms of Uncontrolled Diabetes (3 Ps) Polyuria: frequent, plentiful Polydipsia: frequent drinking to satisfy continuous thirst Polyphagia: excessive Energy Sources The body uses glucose as a principal source When glucose is not available, the body turns to other sources is most abundant. Using fat for energy results in buildup of ketones and fatty acids in blood and tissue. 3

4 Hyperglycemia Lack of insulin causes glucose to build-up in blood in extremely high levels. Kidneys excrete glucose. This requires a large amount of. Without glucose, body uses fat for fuel. are formed. Ketones can produce diabetic. Hypoglycemia Blood glucose is normal. Untreated, results in unresponsiveness and hypoglycemic crisis Signs and symptoms of hyperglycemia and hypoglycemia are. Hyperglycemic Emergencies Diabetic Ketoacidosis (DKA) (1 of 2) in insulin levels. Most common in type 1 diabetes Glucose cannot enter cells. Glucose accumulates in the blood. Body PH Polyuria Diabetic Ketoacidosis (DKA) (2 of 2) Osmotic 4

5 Osmotic Dehydration Shock Cells metabolize fat, produce as waste Retention of by kidneys which leads to cardiac arrhythmias Hyperosmolar Hyperglycemic Nonketotic Coma (HHNC) More often caused by type 2 diabetes Slower, more onset than DKA No sweet-smelling breath Other S/S same as DKA Excessive urination results in. Hyperglycemic Crisis (Diabetic Coma) (1 of 3) A state of unconsciousness resulting from: Ketoacidosis Dehydration Excess glucose Hyperglycemic Crisis (Diabetic Coma) (2 of 3) Can occur in diabetic patients: Not under medical treatment Who have taken insulin Who have markedly overeaten Under stress due to infection, illness,, fatigue, or alcohol 5

6 Hyperglycemic Crisis (Diabetic Coma) (3 of 3) If untreated, can result in Treatment may take hours in a well-controlled hospital setting. Suspect for all patients of unknown etiology Diabetic Coma S/S of DKA Air hunger ( Respirations) Dehydration Sweet, fruity breath odor Rapid, weak pulse Normal or slightly low blood pressure Varying degrees of unresponsiveness onset--over several hours or days Skin is Management of DKA High Con Obtain blood glucose level if authorized Hypoglycemic Emergencies Insulin Shock (Hypoglycemic Crisis) Insulin Shock (Hypoglycemic Crisis) Three causes of Insulin Shock 6

7 overdose taking insulin but not adequately over Decreased blood sugar Brain is deprived of sugar S/S of Insulin Shock Normal or rapid breathing Pale, moist skin Dizziness, headache Rapid pulse Normal or slightly elevated Aggressive or confused behavior Hunger Fainting, seizure, or Weakness on one side of the body Speech Care for Insulin Shock Oxygen Obtain sugar level if authorized Give if conscious (Instant Glucose) Contact ALS backup if unconscious or severe altered LOC Rapid Transport True Diabetic Conditions 7

8 Diabetes and Alcohol Abuse Patients may appear. Suspect hypoglycemia with any altered mental status. Be alert to the similarity in symptoms of acute alcohol and diabetic emergencies. Diabetics may drink alcohol and become intoxicated Emergency Medical Care (1 of 2) Ask a patient with known diabetes: Do you take insulin or any pills to lower blood sugar? Have you taken your usual dose of insulin (or pills) today? Have you normally today? Have you had any, unusual amount of activity, or stress today? Emergency Medical Care (2 of 2) Perform initial assessment. Obtain baseline vital signs and SAMPLE history. Check for emergency medical identification. Always do a full, careful assessment. Ask patient or family about last or insulin dose. DO NOT administer anything by mouth to an patient. DKA vs. Insulin Shock Pt eaten but has not taken insulin? 8

9 - Pt taken insulin and has exercised profusely? - Pt accidentally took two doses of insulin? - Pt has been sick and vomiting lately and has been taking insulin? DKA vs. Insulin Shock Pt has taken insulin and has been eating normally? - Pt has not been eating and has not taken insulin? - When in doubt, GIVE!! Administering Glucose (1 of 4) Names: Insta-Glucose Dose equals grams (one tube) Glucose should not be given to a diabetic patient with a decreased level of consciousness. Administering Glucose (2 of 4) DO NOT give glucose to a patient with the inability to or unconscious. Give between and gums Administering Glucose (3 of 4) Make sure the tube is intact and has not. 9

10 . Squeeze a generous amount onto a stick Administering Glucose (4 of 4) Open the patient s mouth. Place the bite stick on the membranes between the cheek and the gum with the gel side next to the cheek. if needed Complications of Diabetes Heart disease disturbances Renal failure Stroke Ulcers Infections of the feet and toes Altered status Seizures Consider hypoglycemia as the cause. Use appropriate BLS measures for airway management. Obtain glucose level if authorized Call for ALS backup for IV administration of glucose Provide prompt. Geriatric Needs Patient may have 10

11 Patient may have diabetes. Certain symptoms suggest poorly controlled or uncontrolled diabetes. Nonhealing wounds Blindness failure Obtain a SAMPLE history. Check blood glucose level if authorized Blood Glucose Monitors Test Normal range mg/dl There are numerous different glucometers. You must become familiar with the one used on your service. Hematologic Emergencies is the study and prevention of blood-related diseases. Blood is the of life. Understanding it helps understand disorders. Blood Made up of cells and. Red blood cells contain hemoglobin, which carries oxygen to the tissues. White blood cells clean the body. are essential for clot formation. Plasma transports blood cells. 11

12 Sickle Cell Disease (1 of 3) disorder, affects red blood cells Predominant in African Americans and persons of Mediterranean descent Red blood cells are or oblong shaped, contain hemoglobin S, are poor oxygen carriers, and live for only 16 days. Sickle Cell Disease (2 of 3) May cause ; swelling or rupture of blood vessels or spleen; and death Four main types of sickle cell crises: Vaso-occlusive crisis crisis Hemolytic crisis sequestration crisis Sickle Cell Disease (3 of 3) Vaso-occlusive crisis Blood flow to organs is Aplastic crisis Worsening of baseline anemia Hemolytic crisis Acute, accelerated in hemoglobin level Splenic sequestration crisis Acute enlargement of Complications of Sickle Cell Disease 12

13 1 2 Cerebral vascular attack Gallstones Avascular necrosis Splenic infections tolerance Leg ulcers Retinopathy Chronic Pulmonary hypertension Chronic renal failure Clotting Disorders Thrombophilia Tendency to develop blood Blood-thinning medications used to treat Not common in pediatric patients Risk factors: Recent, impaired mobility, congestive heart failure, cancer, respiratory failure, infectious diseases, over 40 years of age, being overweight/ obesity, smoking, oral use Hemophilia (1 of 2) ; impaired ability to form blood clots Predominant in (1 per 13

14 5,000 10,000) Hemophilia A most common Hemophilia B second most common Hemophilia (1 of 2) Signs and symptoms: Spontaneous, acute, chronic bleeding (major cause of death) During assessment, seriously consider injury/illness that can cause bleeding. Emergency Medical Care for Hematologic Disorders Mainly supportive and Patients with inadequate breathing or altered mental status: Administer high-flow O 2 at 12 to 15 L/min. Place in a position of comfort. Transport to hospital. 14